<form id='form_step2' method='post'	action='<?php echo site_url("create_account/save/2")?>'	onsubmit="return Send('#form_step2');">
	<table id="form2_container_tbl" cellspacing='0' cellpadding='0' width="100%">
		<tr>
			<td colspan='4'>
				<div class='lbackground'></div>

				<div class='header_center'>
					Provide Home Address for Primary Account Holder:
				<div class='rbackground'></div>
				</div>
				<div class='msg_important'>P.O Boxes are not accepted</div>
			</td>
		</tr>

		<tr>
			<td>
				<label id='countryMainLbl' for='countryMain'>Country:*</label>
			</td>
			<td colspan="3">
				<select id='countryMain' name='countryMain'>
					<option value=''>Select One</option>
					<option value=''>------------</option>
					<?php foreach($countries as $item){?>
					<option value='<?php print $item->ID; ?>'
						rel='<?php print $item->AREA_CODE; ?>'>
						<?php print $item->NAME; ?>
					</option>

					<?php }?>
			</select>
			</td>
		</tr>
		<tr>
			<td><label for='addressLine1Main' id='addressLine1MainLbl'>Address
					line 1:*</label>
			</td>
			<td colspan='3'><input name='addressLine1Main' type='text' size='45' class="longInput"></input>
			</td>
		</tr>

		<tr>
			<td><label for='addressLine2Main' id='addressLine2MainLbl'>Address
					line 2:</label>
			</td>
			<td colspan='3'><input name='addressLine2Main' type='text' size='45'  class="longInput"></input>
			</td>
		</tr>

		<tr>
			<td><label for='cityMain' id='cityMainLbl'>City/Town:*</label>
			</td>
			<td><input name='cityMain' type='text' size='20'></input>
			</td>
			<td><label for='regionMain' id='regionMainLbl'>County/State:</label>
			</td>
			<td><input name='regionMain' type='text' size='20'></input>
			</td>
		</tr>

		<tr>
			<td><label for='pCodeMain' id='pCodeMainLbl'>Postal Code:</label>
			</td>
			<td colspan="3"><input name='pCodeMain' type='text' size='20'></input>
			</td>
		</tr>

		<tr>
			<td colspan='4'><label for='currentYears' id='currentYearsLbl'>Years
					of current address:* </label> <select id='currentYears'
				name='currentYears'>
					<option value=''>Select One</option>
					<option value='1'>0 - 1</option>
					<option value='2'>1 - 2</option>
					<option value='3'>2 - 3</option>
					<option value='4'>3+</option>
			</select>
			</td>
		
		
		</tr>
		
		
		<tr>
			<td colspan='4'>
				<label for='homePhoneMain1' id='homePhoneMain1Lbl'>Home Phone:* </label> 
				<input id='homePhoneMain1' name='homePhoneMain1' type='text' size='8' maxlength='6'></input>- 
				<input id='homePhoneMain2' name='homePhoneMain2' type='text' size='8' maxlength='6'></input>- 
				<input id='homePhoneMain3' name='homePhoneMain3' type='text' size='12' maxlength='10'></input>
				<br /> 
				<label for='mobilePhoneMain1' id='mobilePhoneMain1Lbl'>Mobile Phone: </label> 
				<input id='mobilePhoneMain1' name='mobilePhoneMain1' type='text' size='8' maxlength='6'></input>-
				<input id='mobilePhoneMain2' name='mobilePhoneMain2' type='text' size='8' maxlength='6'></input>- 
				<input id='mobilePhoneMain3' name='mobilePhoneMain3' type='text' size='12' maxlength='10'></input>

				<div id='phoneHint' class='msg_important'>
					(country code + area code + number)
				</div>
			</td>
		</tr>
	</table>
	
	<div id="space"></div>
	
	<div id='previousAddress'>
		<table id="form2_container1_tbl" cellspacing='0' cellpadding='0' width="100%">
			<tr>
				<td colspan="4">
					<label>Enter previous address:</label>
				</td>
			</tr>
			<tr>
				<td><label id='countryPrevLbl' for='countryPrev'>Country:*</label>
				</td>
				<td colspan="3"><select id='countryPrev' name='countryPrev'>
						<option value=''>Select One</option>
						<option value=''>------------</option>
						<?php foreach($countries as $item){?>
						<option value='<?php print $item->ID; ?>'
							rel='<?php print $item->AREA_CODE; ?>'>
							<?php print $item->NAME; ?>
						</option>

						<?php }?>
				</select>
				</td>
			</tr>
			<tr>
				<td><label for='addressLine1Prev' id='addressLine1PrevLbl'>Address
						line 1:*</label>
				</td>
				<td colspan='3'><input name='addressLine1Prev' type='text' size='45'  class="longInput"></input>
				</td>
			</tr>

			<tr>
				<td><label for='addressLine2Prev' id='addressLine2PrevLbl'>Address
						line 2:</label>
				</td>
				<td colspan='3'><input name='addressLine2Prev' type='text' size='45'  class="longInput"></input>
				</td>
			</tr>

			<tr>
				<td><label for='cityPrev' id='cityPrevLbl'>City/Town:*</label>
				</td>
				<td><input name='cityPrev' type='text' size='20'></input>
				</td>
				<td><label for='regionPrev' id='regionPrevLbl'>County/State:</label>
				</td>
				<td><input name='regionPrev' type='text' size='20'></input>
				</td>
			</tr>

			<tr>
				<td><label for='pCodePrev' id='pCodePrevLbl'>Postal Code:</label>
				</td>
				<td colspan="3"><input name='pCodePrev' type='text' size='20'></input>
				</td>
			</tr>

		</table>
	</div>

	<div id='separate_mailing_container'>
		<input name='separateMailing' id='separateMailing' type='checkbox'
			value='1'></input> <label for='separateMailing'
			id='separateMailingLbl'>I would like to provide a separate mailing
			address:</label>
	</div>
	
	<div id="space"></div>
	
	<div id='mailingAddress'>
		<table id="form2_container_mailing_tbl" cellspacing='0' cellpadding='0' width="100%">
			<tr>
				<td colspan="4">
					<label>Enter mailing address:</label>
				</td>
			</tr>
			<tr>
				<td><label id='countryMailingLbl' for='countryMailing'>Country:*</label>
				</td>
				<td colspan="3"><select id='countryMailing' name='countryMailing'>
						<option value=''>Select One</option>
						<option value=''>------------</option>
						<?php foreach($countries as $item){?>
						<option value='<?php print $item->ID; ?>'
							rel='<?php print $item->AREA_CODE; ?>'>
							<?php print $item->NAME; ?>
						</option>

						<?php }?>
				</select>
				</td>
			</tr>
			<tr>
				<td><label for='addressLine1Mailing' id='addressLine1MailingLbl'>Address
						line 1:*</label>
				</td>
				<td colspan='3'><input name='addressLine1Mailing' type='text' size='45'  class="longInput"></input>
				</td>
			</tr>

			<tr>
				<td><label for='addressLine2Mailing' id='addressLine2MailingLbl'>Address line 2:</label>
				</td>
				<td colspan='3'><input name='addressLine2Mailing' type='text' size='45'  class="longInput"></input>
				</td>
			</tr>

			<tr>
				<td><label for='cityMailing' id='cityMailingLbl'>City/Town:*</label>
				</td>
				<td><input name='cityMailing' type='text' size='20'></input>
				</td>
				<td><label for='regionMailing' id='regionMailingLbl'>County/State:</label>
				</td>
				<td><input name='regionMailing' type='text' size='20'></input>
				</td>
			</tr>

			<tr>
				<td><label for='pCodeMailing' id='pCodeMailingLbl'>Postal Code:</label>
				</td>
				<td colspan="3"><input name='pCodeMailing' type='text' size='20'></input>
				</td>
			</tr>

		</table>
	</div>

	<div id='submit_section' style='text-align: center;'>
		<input type='submit' value='Save & Continue' title='Save the form and continue to the next step' />
	</div>
</form>
